TN 12 (07-08)

Citations:

20 C.F.R. 404.941

20 C.F.R. 404.1520a

20 C.F.R. 416.920a

20 C.F.R. 416.1441

A. Policy Principles

1. Informal Remand to the DDS

IR refers to the process by which a hearing office returns a claim to DDS for review of the previous determination. The actual procedure that DDS undertakes, once it receives the claim from a hearing office is called a “pre-hearing review.” Cases selected for IR are initial claims in which there is a strong likelihood for a reversal of either the initial or reconsideration determination. The DDS decides whether to revise the determination.

The DDS can only process an IR if they are able to make a fully favorable determination on the revised case after they conduct a pre-hearing review. If the revised determination is only partially favorable, the DDS must return the case to the Office of Disability Adjudication and Review (ODAR), where the hearing process continues.

NOTE: The pre-hearing case review will not delay the scheduled hearing unless the claimant agrees in writing to continue the review and delay the hearing.

2. When a Pre-Hearing Review May Be Conducted

Conduct a pre-hearing review if:

• Consequential evidence is submitted;

• Change in the law or regulation has occurred; or

• Error exists in the file or some other indication that revision of the prior determination is necessary.

3. Notice of a Pre-Hearing Revised Determination

NOTE: The DDS does not need to notify the claimant in Title II reversal cases.

When the DDS completes the revised determination, they will mail a notice to all known parties at their last known address. The notice to the claimant explains the following:

• Basis for the revised determination,

• Effect of the revised determination, and

• Rights of hearing.

As the DDS must find the revised determination fully favorable, the notice also explains that:

• The ALJ will dismiss the hearing request 30 days from the date of the fully favorable notice unless a party requests that the hearing proceed; and

• If the claimant wishes to continue the hearing, SSA must receive a request in writing within 30 days after the date of mailing the fully favorable notice.

B. Identification of IRs

1. Field Offices (FOs) May Determine Whether IR Criteria Apply

Only send Hearing cases with the following criteria to the DDS as an IR from the FO:

• A claimant provides new evidence for his or her initial claim that reveals a dramatic worsening of the claimant's condition and/or a significant new impairment of which the DDS was not aware;

• An SSA-832-U5 or SSA-833-U5 for a Continuing Disability Review (CDR) with a basis code of 62 or 13 in item 11 exists. These cases represent Title II, Title XVI, and concurrent (Title II and Title XVI) determinations of cessation in which the recipient failed to cooperate in providing evidence necessary for a continuing disability decision; or

• There is no indication that the claimant engaged in Substantial Gainful Activity (SGA) after his or her alleged onset date (AOD) as this could potentially preclude the DDS determination of a fully favorable onset. Field offices should carefully interview claimants about any subsequent work activity since filing their initial claim for disability benefits.

NOTE: Transfer hearing cases not meeting the informal remand criteria directly to the ODAR Hearing office.

FO Actions When Informal Remand Criteria Apply:

• Include the Request for Hearing by Administrative Law Judge (HA-501-U5) either printed from the Modernized Claim System (MCS), Modernized SSI Claims System (MSSICS), Online Retrieval System (ORS), or other written request;

• Send the case to the DDS with the HA-501 and attach a Route Slip (SSA-408) with the annotation, “DDS Informal Remand Case;”

  NOTE: The HA-501 must be sent to ODAR within 1 business day of the date it is filed per FO Procedures for Forwarding HA-501-U5 (Request for Hearing by Administrative Law Judge) and Folder to HO GN 03103.080C.

• Forward a copy of the HA-501-U5 to the ODAR office, which would have had jurisdiction with the Route Slip (SSA-408), annotated “DDS Informal Remand Case”.

• Add a remark to the REMARKS segment of the SSR or on the Report of Contact (DROC) screen indicating that the hearing request meets the criteria for an informal remand.

2. Processing Center (PC) and the Office of Quality Review (OQR)

If the PC or OQR receive a hearing request, follow the instructions as detailed in “Hearing Request Filed Someplace Other Than Servicing FO” GN 03103.090.

3. ODAR Assistance Requests

ODAR offices send an Assistance Request (AR) to the DDS in the following situations:

• Additional existing medical evidence is requested through the DDS; or

• The ALJ needs a consultative examination ordered or medical expert services to assist in applying the psychiatric review technique and one is not available to the ALJ.

See Details

• DI 81020.100 - Electronic Assistance Requests (AR)

• DI 29501.001 - Background — Assistance Requests from the Office of Disability Adjudication and Review (ODAR)

In the event the DDS makes a fully favorable determination, ODAR is responsible for dismissing the hearing request. If the DDS cannot make a fully favorable determination, ODAR keeps jurisdiction and proceeds with the hearing.